The medial ulnar collateral ligament (MUCL) complex is integral for valgus elbow stability, especially in individuals engaged in repetitive overhead activities such as throwing. MUCL injuries often necessitate surgical intervention to restore elbow stability. Early studies reporting outcomes after MUCL repair demonstrated suboptimal return to play compared with ulnar collateral ligament reconstruction, prompting a shift toward reconstruction techniques. The first widely popular MUCL reconstruction technique was the Jobe technique. Many reconstruction techniques have since been described. Despite advancements, most reconstruction techniques do not fully restore native MUCL stiffness. Internal brace augmentation to MUCL reconstruction presents a promising adjunct to traditional MUCL reconstruction, with recent studies showing improved biomechanical performance compared with MUCL reconstruction alone. Clinical studies have yet to prove better clinical outcomes or shorter recovery time after MUCL reconstruction with an internal brace. It is important for the surgeon to have comprehensive knowledge about MUCL anatomy, the historical evolution of surgical techniques, biomechanical considerations, and clinical outcomes of MUCL reconstruction.